A Look at Midwifery:
Back to Natural Birth
Tehmina Islam is Wisconsin’s  first
person of color to be a certified
professional midwife.

By Jonathan Gramling

Part 2 of 2

For the Baby Boom generation and beyond, it may seem that it has always been hospitals
where babies were born, that it is only “natural” that a woman goes to a hospital to give
birth. After all, 99 percent of births in the United States are in hospitals. But at the beginning
of the 20th century, the vast majority of births were done at home under the care of a
general practice physician or a midwife.

As a high school student in Madison, Tehmina Islam first witnessed a birth when her
friend, also a 16-year-old high school student, asked her to be in attendance at her child’s
birth. It was that experience that eventually propelled Islam to pursue a vocation and
avocation as a midwife and currently operates Access Midwifery LLC out of her home just
off of Williamson Street.

Midwifery is natural childbirth that has the relationship between the midwife and the
mother as the center of the birthing process. Each visit, which lasts an hour, involved
only the midwife and the mother. Over the course of the nine-month pregnancy, a relationship based on trust and communication that is
imperative for a positive birthing experience, is formed.

“During your prenatal visit — they last an hour or more — it’s really just one-on-one care,” Islam emphasized. “They’re getting an hour
visit where we talk about nutrition, supplements and how they are doing and how their body is handling the pregnancy. We measure the
baby with a measuring tape. And we palpate to know the baby’s position. We listen to the baby’s heart tones, which is a good sign of the
fetal health. And we really try to incorporate the mom and the family into the care as much as possible. So we show her how to feel her
own body and allow her to listen to the heart tones as well. Sometimes we use a Doppler, which is an ultrasound to listen to the baby,
or use a fetus scope, which is more of a traditional tool to listen to the baby’s heart rate.”

When one says it is natural, they mean natural. There are no drugs involved.

“A lot of our clients will really educate themselves about natural childbirth and about ways to cope with it and really mentally prepare
for the hard work that is labor,” Islam said. “Pain medications don’t often cross your mind when you are in the throes of labor because
you have prepared yourself to manage as best as you can. And that is also why you have a good support team, why you’ve called a
midwife and why you have involved your partner hopefully in your care so that you do have people you can rely upon to get through it. It
is natural childbirth and that natural childbirth really allows the avenue for all of your hormones to be at their peak so that when you
birth that child, you are having bonding hormones. You’re having oxytocin flow through your body and flow through your baby and that
really allows bonding to take place between mother and child.”

With natural childbirth, it is the mother who is in control although there are rules and guidelines that must be followed. For instance a
birth at home can only occur during the 37th to 42md week of pregnancy. If labor begins before or after that time, the mother must
deliver in a hospital where she can access a certified nurse midwife or the traditional hospital birthing procedure. But at home, it is the
partnership between the midwife and mother that creates a positive birth experience.

“She may call to let me know that she is experiencing some contractions or that her water might have broken or she is starting to see
her mucus plug come out,” Islam said about the beginning of the birthing process. “So she might start to feel the signs of labor slowly
come on. We may stay in touch by phone. I might make a home visit and check in and then she calls me when she is ready for her
midwife to be there. That might be in the middle of labor. That might be towards the end of labor. That might be early in labor.

“But I provide continuous support and monitor her health. I take her vitals. I monitor the baby’s health and listen to the baby’s vitals and
heart rate. I rarely do vaginal exams. I only do that at the mom’s request of if there would be a need for it. But a lot of midwifery care is
sitting on your hands and really just being vigilant and watchful and supportive. You only intervene when there is a need, but not
intervening because you are trying to create an intervention. I might intervene because there is some stalling of labor, but I wouldn’t do
a vaginal exam just to know how she is doing every two hours. I ask her to let me know how she is doing and do a vaginal exam if her
outward signs of labor are not showing that she is making progress. So we follow a lot of outside cues as well in addition to monitoring
her vitals and internal exams and things. It is pain medication free. We offer the option of having a water birth. So we bring a big warm
tub that we can fill up with warm water and she can either labor in there to help with the pain or she can birth her baby there as well in
the water. But we try to use natural remedies like massage, warmth, water and position changes. We use some herbs and homeopathic
remedies to help with the stalling of labor or mood. But yes, it is natural childbirth.

“We stay until she has birthed her baby. I don’t ever say that I delivered the baby because the mom really does all of that work. I just
attend the birth as midwife. And we stay a couple of hours postpartum. We make sure that her bleeding has decreased or is stable. We
monitor her vitals postpartum. We make sure that the baby had breastfed at the breast. We make sure that we do a dull newborn exam
on the baby before we leave to make sure that his or her vitals are stable and mom and baby are comfortable. And then we leave and
return in 24 hours. We do a newborn and mom check at 24 hours and then we return at three days, at two weeks and at six weeks.”
During this whole period while she is being attentive to mother and child, Islam is following strict guidelines that dictate what happens
if any complications arise. If certain thresholds are met, it is off to the hospital for more intensive medical care.

Islam is the first person of color to be licensed in the state of Wisconsin as a midwife. And she feels it is important for more women of
color to get involved in natural childbirth as midwives and as mothers.

“It is especially important to me because midwifery care has good birth outcomes and in Dane County, if you are a Black woman, you
have a four times greater likelihood of having your infant die than a white woman when you are pregnant,” Islam said. “I think that
midwifery care could potentially be a solution to decreasing infant mortality and I think it is more individualized, has more continuity of
care and has therefore has the potential to have better outcomes for higher risk women or women of color who just through racism face
a greater likelihood of having their infant die. And so, partially it is that I am a woman of color and I want to see more women like out
there. And partially, midwifery care shows good outcomes and I think women of color deserve that chance of having a good birth
outcome, which isn’t the case right now.”

Islam emphasized that natural childbirth isn’t for everyone. And although the services of a midwife can cost $1,500-$3,500 — Islam
charges a sliding scale fee — it shouldn’t be done just as a way to save money although economics continuously play a bigger role in
health care. It should be done for the benefits.

“It’s Every woman has the right to choose a home birth and midwifery care,” Islam said. “In my humble opinion, I think that if a home
birth and hiring a midwife is where you feel safest and most secure and most comfortable, if that model of care offers so many
advantages, then people should be able to avail themselves of it. There was a study in 2005 that recently compared low-risk women in
the hospital to low-risk women at home. The cohort group was over 5,000 women in the United States. The women who had their babies
at home had a lower c-section rate, a lower epidural use rate, a lower rate of episiotomies, a lower rate of medical interventions in
general and a lower rate or preterm births and low birth weight babies. So the outcomes are good in home birth. In that same study, the
neonatal and maternal mortality risks were the same. So the risks were the same to baby and mother, but the benefits exceed when
done at home.”

Natural may just be the way to go.

For more information about midwifery, Tehmina Islam may be contacted at
accessmidwiferywi@gmail.com or 251-0776.